Drug Firms Say They’ll Take Closer Look at the Docs They Pay

Seven drug companies paid $7.1 million to 292 doctors who faced disciplinary action or other regulatory sanctions, ProPublica found. Several companies say they may take steps to tighten screening procedures for physicians who are paid as speakers or for other activities promoting prescription drugs.

Several of the nation's largest pharmaceutical companies said they plan to tighten screening of physicians who promote their drugs after ProPublica reported last month that more than 250 of them had been sanctioned for misconduct.

Eli Lilly and Co. said that next year, for the first time, it would hire an outside firm to search for state disciplinary actions against its hired speakers and advisers. Lilly, the seventh-largest company by U.S. prescription sales, did not previously conduct such screening and was unaware of the dozens of actions ProPublica found against its speakers.

"Your reporting has raised valid and important questions, which we have taken steps to address," spokesman J. Scott MacGregor said in a statement.

AstraZeneca, the third-largest firm, is "evaluating new ways to retrieve state disciplinary actions that would allow us to act on that information in a timely manner," spokesman Tony Jewell said in an interview.

Pfizer, the largest U.S. company, said in a statement that it is doing the same.

Last month, ProPublica published an online database, Dollars for Docs, that includes payments from seven pharmaceutical companies to health providers in 2009 and 2010. A review then of medical board sites in 18 states turned up more than 250 doctors who had been subject to various regulatory sanctions.

Based on checks with medical boards in the 30 most populous states and warning letters issued by the U.S. Food and Drug Administration, we have found dozens more. Today, we are publishing a list of 292 physicians who have had government actions taken against them, as well as the companies that paid them.

Physicians with minor, nonmedical infractions -- such as failing to update addresses or take continuing medical education courses -- were not included.

We also have updated our database to include recently reported drug company payments, adding another $24 million and bringing the amount paid to physicians in 2009 and 2010 to nearly $282 million. The physicians with government actions received $7.1 million of this amount.

(Our database includes payments from only seven of more than 70 drug companies; the others have yet to disclose. Details are here.)

The sanctions against physicians were for misconduct such as prescribing unjustified or excessive medications, having inappropriate sexual relations with patients and making serious medical errors. Seventy physicians have been sanctioned multiple times or by more than one state. Twenty-one of these physicians had three or more strikes against their records.

On Probation, but Still Speaking

Dr. Kenneth Fisher has been disciplined five times between 1996 and 2009, the most of any physician on the list. The Arizona Medical Board has put him on probation twice, required him to have a chaperone when seeing patients and issued him three letters of reprimand for medical and recordkeeping lapses.

In the most serious case, in 1999, numerous male patients accused Fisher, a Phoenix family practitioner who specializes in HIV, of sexually victimizing or violating them, according to the medical board records. Fisher's license was on probation for more than nine years.

In an interview, Fisher disputed his culpability in each of the cases and said the 1999 action involved a few disgruntled patients coached by a physician who didn't like him.

Fisher said his disciplinary record has never kept him from working as a drug company speaker because of his renown as an expert in HIV treatment. He currently speaks for three companies, including GlaxoSmithKline, which paid him $11,000 in 2009.

"I think my local Glaxo [sales] reps understand the nuances of the complaints," he said. Still, Fisher said drug companies should check the backgrounds of their speakers. "I think it should be a consideration but it should not be a litmus test," he said.

Another physician, cardiologist Ali Sherzoy, had his license suspended in New York and New Jersey this year after he pleaded guilty to one count of criminal sexual contact in 2008.

Sherzoy said the matter involved his family's nanny and not his practice. He said he pleaded guilty on his lawyer's advice to put the matter behind him.

"I am the best physician around," Sherzoy said. "Ask any of my patients, ask anyone, ask my staff." He added: "I pleaded to something that I shouldn't have. I didn't even know all the ramifications of this. To bring it back up, it is just not fair."

Sherzoy's wife, Roshana, said she stands by her husband: "It had nothing to do with his patients."

Lilly used Sherzoy as a speaker in the first and second quarters of this year, the company's website shows, even though New Jersey suspended his license on Jan. 15. Lilly paid him $4,334 in the first two quarters of this year.

"They asked me because I'm one of the best and I think people trusted me," Sherzoy said. "When I spoke for the drugs, it's because I believed they work."

Pledges to Review Records

ProPublica provided each of the seven drug companies with a list of its sanctioned physicians. All said they plan to review the names and take appropriate action if warranted.

Lilly and Glaxo each had more than 100, while Johnson & Johnson with 21, and Merck, 18, had the fewest.

The companies did not make officials available for interviews. Most declined to say whether or how they would alter practices to learn about sanctions or other blemishes on the records of speakers or consultants. Pfizer and Glaxo noted that some of the physicians listed no longer speak for them.

Pfizer also noted that none of its doctors had been banned from participating in federal health programs.

Merck & Co. said it had "previously initiated" plans to conduct more frequent background checks and "is exploring additional capabilities." The firm would not be more specific.

Johnson & Johnson, Glaxo and Cephalon each said that they are always looking for ways to enhance their selection of speakers.

In an e-mail, Glaxo spokesman Kevin Colgan added that disciplinary actions alone shouldn't be the basis for excluding a potential speaker or consultant.

"When looking at state disciplinary records, it is important to note such an examination would have to take into account differences between accusations and findings of wrongdoing; differences in the severity of infractions; whether infractions are isolated incidents or patterns of behavior; and how long ago an infraction occurred," he wrote in an e-mail.

That said, Glaxo does not routinely look at such records when hiring speakers.

Dr. Humayun J. Chaudhry, chief executive of the Federation of State Medical Boards, said pharmaceutical companies could easily ask his group to search for discipline in any state against any of their physicians -- and even get alerts if something changes. Simply checking to see if a doctor is excluded from participating in federal health programs -- what most companies do -- is not enough, he said.

"If I'm sitting in an audience listening to a physician tout a certain drug and I was aware of those disciplinary actions," Chaudhry said, "I would have questions about their character and their motivation for talking about that subject -- and I would imagine that the pharmaceutical companies would also have similar concerns."

Josephine Johnston, a research scholar at the Hastings Center, a nonprofit bioethics think tank in New York, said she found it difficult to believe that multibillion-dollar drug companies haven't done simple background checks.

"Let's be honest, they do a lot of very complicated things very well," she said. "These are the people who have figured out how to get prescription data for individual doctors so they can send drug reps to target particular doctors in particular ways."

For this article, ProPublica shared the disciplinary actions it gathered with several news organizations, including The Dallas Morning News, The Detroit News, Health News Florida, the San Francisco Chronicle and WNYC in New York City. Reporters examined the disciplinary records of physician speakers in their regions. Among the findings:

WNYC reports that Long Island psychiatrist Richard Schloss spoke on behalf of Pfizer's antipsychotic drug Geodon even though New York suspended his medical license in 2001 and placed him on probation for five years for helping supply Vicodin to six patients who were drug addicts. Schloss told WNYC that Pfizer never asked about his record. "No, it did not come up. They didn't bring it up, and I didn't volunteer it but if they asked, I would have been forthcoming, obviously."

The Dallas Morning News reports that psychiatrist Wayne Jones was disciplined in 2000 after accusations that he had improperly prescribed drugs to several patients, including one who died of an overdose, according to Texas Medical Board records. The board required him to have a monitor to oversee his practice and keep detailed records of his prescriptions. Another accusation is pending against him for similar failings.

Jones has given more than 1,300 presentations on stress disorders, according to his website, askdrjones.com. Jones told the Morning News he couldn't discuss treatment of specific patients, but said relatives often make allegations when struggling with loved ones who are mentally ill.

Health News Florida reported how Orlando-area urologists Steven Brooks and E. "Jake" Jacobo pleaded guilty on Jan. 12, 2001, to one count of conspiracy to sell the prescription drug Lupron without complying with U.S. Food and Drug Administration regulations. The doctors were sentenced to five years' probation and 500 hours of community service, and their practice had to repay the government $1.1 million. The Florida Board of Medicine fined each doctor $10,000 and required each to take classes in medical ethics and risk management. New York, where Brooks held a license, was much stricter. Its Board for Professional Medical Conduct pressured him into giving up his medical license. Glaxo paid Brooks $178,250 from 2009 through mid-2010, while Jacobo received $14,750 over that time. Neither returned calls from Health News Florida.

Separately, Colorado Public Radio reviewed Dollars for Docs data and found that at least 84 Colorado physicians did not follow state law and disclose their contracts with drug companies. Doctors are required to disclose such relationships worth more than $5,000 so that patients can weigh whether the advice they are giving might be biased, CPR reports.

Correction: Health News Florida has corrected a story we summarized in this report. Orlando-area urologists Steven Brooks and E. "Jake" Jacobo pleaded guilty on Jan. 12, 2001, to one count of conspiracy to sell the prescription drug Lupron without complying with U.S. Food and Drug Administration regulations. The Nov. 18 story and our summary mischaracterized the plea.

The case with the Zyprexa scandal is that Eli Lilly drug company pleaded guilty to criminal wrongs (“viva Zyprexa” campaign) the Zyprexa saga was rotten through and through.
Eight Lilly EMPLOYEES got millions each as supposed informant ‘whistle blowers’.Lawyers on BOTH sides got millions and millions…...most patient claimants who got sick are ‘mentally challenged’ and less able to advocate for themselves.
The Class action Lawsuits in the US had payouts of $85,000 BUT the lawyers got 45 percent and then the govt got most of the rest for having to take care of the victim/patients medical expenses.Soooo,,,,$85K turned into about $9,000 for Zyprexa claimants many had their food stamps and other state benefits taken away because of their *windfall profit* making them worse off in the end.
*
Daniel Haszard Zyprexa victim activist and patient who got diabetes from it. http://www.zyprexa-victims.com

I have addressed this matter, in part, in my current article on medical ethics in The Rag Blog.

In the local morning paper in letters to the editor, a local physician defends the practice of subsidized physicians presenting programs underwritten by the pharmaceutical companies, as a way for physicians to remain current in their knowledge. This is an absurd argument for one in most communities have weekly hospital sponsored medical conferences, one has yearly meetings within the USA of their speciality societies (for instance the American College of Physicians, The Endocrine Society, etc), and one has a huge variety of medical journals available.

Referring to the press Ben Franklin once said “I’d rather be uninformed than misinformed.”
Pro Publica has turned the ability to misinform into art form or better yet a magic act filled with all the illusion of a David Copperfield show. They stand beneath the banner of “journalism in the public interest.” They create the illusion that their story is accurate and unbiased. Isn’t that how the press always casts themselves. Knights on white horses exposing the evils of society.

It is often what they don’t tell you that allows the illusion to become reality
Todays Dallas Morning News using information supplied by Pro Publica pens the article “Drug firms pay doctors sactioned by the state.” OMG doctors are getting paid by drug companies to teach other doctors about the use of their medications. We must put a stop to this and return the educating of doctors back in the hands of the drug reps where it belongs,
But, you say, I am missing the point These doctors have had complaints filed against them by patients and in some cases sactioned by the board.
First, the article in the News and this Pro Publica article takes the “good, bad and the ugly” and treats them all the same. That’s another part of the illusion. I have known Dr. Wayne Jones professionally for 30 years and have yet to find a psychiatrist who can equal his knowledge and treatment skills. He accumulates more continuing education credits in one year than most acquire in 10 years. He has the highest certification you can get in clinical psychopharmacology. He treats the most difficult patients in the toughest medical specialty, psychiatry.When the reporter for the News was given my name as someone who could attest to Dr. Jones skills, he never bothered to call. He had to keep the illusion protected

Second, when a complaint is filed with the medical board in Texas, it is reviewed by a lay person, two attorneys and a physician from a completely different specialty. Never do doctors from the same discipline review the complaint. Does this make sense?

You fail to mention that if a physician has an accusation raised, that they are not by law, guilty. There are physicians you cite in your original article that had not been disciplined at the time they were speaking on behalf of drug companies. In this country, you are innocent until proven guilty.

You also fail to put into perspective that some of these physicians have seen thousands of patients, and many are good doctors. Not all reprimands constitute that doctors are bad. You seek to discredit drug companies, but you are seriously discrediting the livelihoods of physicians who are protected by the same first amendment rights as you.

Mr. Ornstein, you are have admitted to factual errors in your article, yet you have failed to make any corrections. WHY DON’T YOU?

Does your style of journalism not constitute marketing to suit ProPublica’s interest, just like a drug company?

If you ever need a drug, please don’t take it—- even if it could save your life.

Bravo. ProPublica claims to conduct investigative journalism. This is a joke.

By going out to all the media outlets, they serve only one: themselves, because they get referenced each time. Great marketing idea. Just as good as the drug companies using doctors to promote their drugs!

It’s about money and the effort of the medical team to have a great medicine; a right one and must be effective. They are also human and sometimes they fail in their work like us as a worker, we’re not perfect but we make sure to have a great result.:)

I believe you. You are not in a true court of law—once you get an accusation you are doomed, no matter how ridiculous the claim.

Those who sit on Medical Boards are not the best and brightest, by the way, otherwise they’d be out there practicing real medicine. The same goes for the district attorneys—really…. the best and brightest? They are okay for a witch hunting these cases, but put them in a real court of law, and they are doomed.

One must keep in mind that the reporting by Pro-Publica, although very well documented, will not be to the liking of the pharmaceutical cartel; hence, will bring about any number of adverse comments regarding the reporting, the sources, and the intent.

The unsophisticated, uninformed public in the U.S.A. will believe any big lie which is repeated over and over regarding any honest journalism as per the Pro-Publica articles. The health insurance industry and pharmaceutical companies are masters of misleading the people with misinformation and partial truths. This became apparent during their campaign against any realistic universal health care.

I do agree with you to a degree. But outing individuals and maligning them all as bad physicians and doctors at the expense of exploiting the drug companies should be at least factual regarding sourcing. Per their article
1. All physicians are bad doctors who accept money.
2. All physicians recommend the drugs they speak for instead of doing what is right for their patients
3. Most of these physicians are not experts. Does one have to publish to be an expert? Where does the money come from to do clinical trials—the NIH? Not
4. Doctors on probation are all bad— put them all in the same bucket—from documentation to murder. They stink. OF course, if a journalist makes a factual error, how often do they live up to it to correct it?
4. Please, as a physician, are you not afraid of how most medical boards operate? Have you ever had a patient file a claim against you and had an accusation? Have you ever been through the charade of administrative law? Tell me you haven’t met a physician that wasn’t screwed by the medical board to suit some District Attorney’s CV? I am not saying there are not bad doctors out there, but how about this: I am your wife and we are going through a divorce and I decide I am going to file a complaint to the medical board because you prescribed a drug to my sister over state lines. Did you know that could get you put on probation for 5 years? Well, maybe not if you plea bargain.
5. Doctors who have been accused of wrongdoing are bad, even though when they were speaking for the drug companies they were not, legally, technically, or otherwise, on probation or guilty of anything—yet they willingly worked for drug companies and the drug companies hire bad people. No corrections in this regard. Let’s just damage their careers through innuendo instead of facts.

I am for universal health care. I have worked for the drug companies. I have worked for non profits. I am a democrat. I have friends who are doctors. I have some very powerful friends in the media and who are journalists for NPR, MSNBC and the NY Times. All of them have their reservations about ProPublica, and see their form of journalism as self serving. Hey, I read Mother Jones and I am a fan of Unte. But i have now seen first hand how biased reporting can ruin the lives of the innocent to make a point about big business. . I don’t know about you, but I would rather take my ire out on Wall Street, which puts companies and individuals under pressure to make profits for their investors. Get rid of capitalism, and all this will go away.

And then we can have socialized media like ProPublica who are not interested in just making a point, but making sure that lives are ruined and they get referred by every newspaper or media outlet in the country as “real’ investigative journalism. The implication there, I guess, is that these media outlets are too damn lazy to do their own work and since ProPublica has published it, IT MUST BE RIGHT.

And again, ProPublica is run and has been founded by some big fat cat capitalists who have worked for a lot of pro-industry publications.

Sorry Dr Keister, there are good and bad in all professions. This article takes a very one sided view. We all have first amendment rights, but the days of real balanced journalism? People don’t know how to read and write and sift through the facts. Including the writers of this article. I mean, their educational backgrounds aren’t exactly high pedigree, if you know what i mean.

I do agree with you to a degree. But outing individuals and maligning them all as bad physicians and doctors at the expense of exploiting the drug companies should be at least factual regarding sourcing. Per their article
1. All physicians are bad doctors who accept money.
2. All physicians recommend the drugs they speak for instead of doing what is right for their patients
3. Most of these physicians are not experts. Does one have to publish to be an expert? Where does the money come from to do clinical trials—the NIH? Not
4. Doctors on probation are all bad— put them all in the same bucket—from documentation to murder. They stink. OF course, if a journalist makes a factual error, how often do they live up to it to correct it?
4. Please, as a physician, are you not afraid of how most medical boards operate? Have you ever had a patient file a claim against you and had an accusation? Have you ever been through the charade of administrative law? Tell me you haven’t met a physician that wasn’t screwed by the medical board to suit some District Attorney’s CV? I am not saying there are not bad doctors out there, but how about this: I am your wife and we are going through a divorce and I decide I am going to file a complaint to the medical board because you prescribed a drug to my sister over state lines. Did you know that could get you put on probation for 5 years? Well, maybe not if you plea bargain.
5. Doctors who have been accused of wrongdoing are bad, even though when they were speaking for the drug companies they were not, legally, technically, or otherwise, on probation or guilty of anything—yet they willingly worked for drug companies and the drug companies hire bad people. No corrections in this regard. Let’s just damage their careers through innuendo instead of facts.

I am for universal health care. I have worked for the drug companies. I have worked for non profits. I am a democrat. I have friends who are doctors. I have some very powerful friends in the media and who are journalists for NPR, MSNBC and the NY Times. All of them have their reservations about ProPublica, and see their form of journalism as self serving. Hey, I read Mother Jones and I am a fan of Unte. But i have now seen first hand how biased reporting can ruin the lives of the innocent to make a point about big business. . I don’t know about you, but I would rather take my ire out on Wall Street, which puts companies and individuals under pressure to make profits for their investors. Get rid of capitalism, and all this will go away.

And then we can have socialized media like ProPublica who are not interested in just making a point, but making sure that lives are ruined and they get referred by every newspaper or media outlet in the country as “real’ investigative journalism. The implication there, I guess, is that these media outlets are too damn lazy to do their own work and since ProPublica has published it, IT MUST BE RIGHT.

And again, ProPublica is run and has been founded by some big fat cat capitalists who have worked for a lot of pro-industry publications.

Sorry Dr Keister, there are good and bad in all professions. This article takes a very one sided view. We all have first amendment rights, but the days of real balanced journalism? People don’t know how to read and write and sift through the facts. Including the writers of this article. I mean, their educational backgrounds aren’t exactly high pedigree, if you know what i mean.

“Second, when a complaint is filed with the medical board in Texas, it is reviewed by a lay person, two attorneys and a physician from a completely different specialty. Never do doctors from the same discipline review the complaint. Does this make sense?”

======================================
This statement is incorrect. Complaints regarding standard of care issues against doctors licensed by the Texas Medical Board are specifically referred to two doctors in the same specialty on their Expert Physician Panel for review and opinion.

We are digressing a bit but this Board situation is a story in itself.

In theory you are correct, and that is generally true in most states. There have have been some really wacky cases of “experts” (and I use this with caution) out there who represent the board. A more subtle one, for example, is a case two years ago (I’ll leave the state unmentioned)., a child psychiatrist reviewed a case pertaining to an adult patient with borderline syndrome—that was and still is a very ill patient, suicidal ideation and actual attempts, documented liar, substance abuser. The board took his complaint hook line and sinker. First, these types of patients aren’t treated by child psychiatrists. He filed a negative review based on the patient’s accusations and recommended revocation of the doctor’s license (as I suspect you are aware, in the majority of cases the doctor is threatened with revocation—this is a great plea bargain strategy on behalf of the board—or should I say the district attorney. The board actually doesn’t get involved in most cases until later.) Pursuant to that, the “Medical Board” (aka, the DA) threw him out as an expert since they found he hadn’t been creditable in the past. Of course that would have provided ammunition to the accused, would it not? So the Board got another opinion, even though the original one was refuted and was the basis for the case.

Most of these cases are open, btw, and are not sealed. You just have to have the time to dig them out.

Of course, the DA cherry picks an expert that will suit their case.

Another recent case was an expert who had represented the medical board on a number of cases, but when that expert represented an accused doctor, for types of cases he has served on in the past (just sitting on the other side of the fence) he was found “not convincing” by the judge.

I am laughing all the way to an insane asylum.
If you took 90% of these cases and tried them as malpractice ones, they’d fall flat on their face.

You cannot tell me that the way Medical Boards operate is fair. It is like the wild west. As an accused physician, you have lost your rights. And the more you try to fight the case, the more they attempt to screw you. These people want gold stars on their resumes. They force you to plea—that’s how you get off faster—even if you have killed a patient due to negligence.

I am actually shocked there has been some sort of class action suit against Medical Board policies and procedures. A colleague once said it is essentially a lynching—and trust me, with state budgets being cut, a lot of these investigators and DAs want to keep their jobs.

There are also laws and rules that you find out after you are on probation and you take these “ethics and documentation” courses that read you the “law”—“laws” you were never taught in Medical School, things that thousands of doctors do a day to day practice that is illegal and they don’t even know it.

I am a dumbfounded by this piece. Is it always, BIG BAD PHARMA? What about the trillions of dollars they throw away, yes I said throw a way every year when conducting research? A drug is investigated for several years say 8, and then it doesnt get approved. The money is gone. Oh I am sorry, how much money is the government putting into drug research? Oh and how much are MANAGED CARE ORGANIZATIONS like Blue Cross Blue Shield, United, AARP raping, yes raping our doctors? Doesnt the FDA have anything better do to with their time? I have had it with this type of coverage.

How is it that our government able to blasts other countries for being corrupt. When its our .05% that corrupted them to begin with. We have to do something about Capitalism before it dooms us all. Heck we might end up in another war or a world because we offered protection and war toys to let us drill for oil of the South Koreans coast. Just maybe that why North Korea so pissed and wants a nuke. Then Pointing fingers at China without proof of aiding The North Koreans is a big mistake. The second is having Hillery Clinton to talk to chines leaders when they think women belong in the kitchen bad Idea! How do these morons become leaders.

I would love to see PRO/PUBLIC start some investigations into the penile prostheses industry and see how many failures are reported to the FDA as they are required to do along with the medical centers where the surgeries are performed.This is not happening so there is no way clear records can be kept.

I have had this surgery 2-11-10,,6-30-10 and 11-11-10 with no success and have been informed by my doctor that the first two failed because of faulty pumps and are still waiting to see results on the third surgery.I have checked and none of these failed pumps have been reported to the FDA by anyone.

This is a very painful surgery with bad results and I am afraid that other men have been through the same with the same outcome and no one is reporting this to anyone and doctors and the mfg.co are remaining silent on this matter and that many more men may go through what I have been through and this just is not correct by any standard.

ProPublica is tracking the financial ties between doctors and medical companies.

The Story So Far

ProPublica is investigating the financial ties between the medical community and the drug and device industry. In October 2010, ProPublica compiled the list of payments that drug companies make to physicians and built a publicly searchable database so that patients could look up their doctors.

Safeguard the public interest

Republish This Story for Free

Thank you for your interest in republishing the story. You are are free republish it so long as you do the following:

You can’t edit our material, except to reflect relative changes in time, location and editorial style. (For example, "yesterday" can be changed to "last week," and "Portland, Ore." to "Portland" or "here.")

If you’re republishing online, you have to link to us and to include all of the links from our story, as well as our PixelPing tag.

You can’t sell our material separately.

It’s okay to put our stories on pages with ads, but not ads specifically sold against our stories.

You can’t republish our material wholesale, or automatically; you need to select stories to be republished individually.